Specialization within medicine, a trend that is nearly a century old, is still a hotly contested subject. Within orthopaedics, for instance, we are debating the merits of a new Board of Spine Surgery and new Certificates of Added Qualifications. The concern about specialization extends to academic medicine as well, where the so-called "triple threat"-the physician who excels at clinical care, teaching, and research-is threatened with extinction by those who concentrate in only one of these three areas. Traditionalists may decry this trend toward increasing specialization, but the better response is one of wonder. We must ask: Who is killing the generalist-and why?